September 2022 Advice to Be Well From Dr. Mark Bornstein and Dr. Paul Benson

From Dr. Mark Bornstein and Dr. Paul Benson

Hi doctor. I am a 60-year-old cis male and my doctor recently told me that I do not need to be screened for prostate cancer. My father has been getting this screened every year since he was 50. This is confusing! Am I missing something?

This is a great question and you are absolutely right, this is confusing. Prostate cancer screening has changed over the years and I want to make sure you have all the information available so that you can make the best informed decision. The American Urological Association released new guidelines for this in 2018 that are still in effect. This was a change from prior practices. The main reason for this change was that patients were getting procedures performed that were causing more harm than benefit.

Both the American Urological Association and the United States Preventative Task Force recommend individualizing prostate cancer screening with PSA testing. This means each patient may elect or defer screening for their own individualized reasons. It is important to know that the PSA test is not a great test, but it is the best test we have for now. The PSA is frequently inaccurate with events such as recent ejaculation or any prostate stimulation falsely elevating the PSA. Even riding a bike can cause a false elevation! Additionally, if an individual is taking finasteride or dutasteride, it will falsely lower the PSA, so it is important that your doctor knows what medications you take. If you do get PSA testing, its now recommended to only check every 2 instead of annual testing. This interval can also be individualized.

Another good fact to know, is that most men with prostate cancer will die WITH prostate cancer and not FROM prostate cancer. This is because most prostate cancer is very slow growing.

All that being said, prostate cancer screening should be a shared and individual decision with you and your provider. Benefits of testing are early detection of prostate cancer. One study showed that screening may prevent 1.3 deaths from prostate cancer per 1000 men screened. This is quite low in terms of cancer screenings. Harms of frequent PSA testing are that it opens a door where biopsies and prostatectomies may end up being performed which can cause erectile dysfunction, urinary incontinence and even bowel symptoms. If they had not been screened, these procedures and side effects may have been prevented.

In summary, prostate cancer screening is complicated. I would encourage you to have open conversations with your provider about prostate cancer screening so that both of you can determine the best course of action for you going forward.

We hope this helps!

I have just recovered from Monkeypox. I initially was treated for a strep throat that eventually was diagnosed as Monkeypox after I developed a skin rash. Do I still need to be vaccinated against Monkeypox? Who should be vaccinated against Monkeypox? What’s this I heard about a micro dose of the vaccine? – JB

Dear JB,

These are all great and important questions. Clinicians and the general population need to be aware of Monkeypox, because if symptoms are not considered early on, the diagnosis may be missed or delayed. This delay could increase the spread of Monkeypox. It is transmitted by touching, including sexually, with an infected individual. It is not easily spread through the air. Symptoms may imitate other infectious diseases. The classic textbook skin lesions may not occur until days after other symptoms. Monkeypox is a new disease in this country and healthcare providers need to consider it when evaluating patients. We’ve seen late or missed diagnoses of Monkeypox as sore throats, rectal herpes, and warts instead of Monkeypox.

High risk activity includes men having sex with multiple male partners, or close contact with someone you know having Monkeypox. This must be communicated to your health care provider. Health care providers should be asking the right questions by taking sexual histories, although that is not always the case. Without knowledge of an individual’s risk would make it impossible to give good advice for prevention. No one is saying not to have sex, just be smarter and aware of your choices, especially if one is having symptoms of being ill or having a skin rash. Also, the Monkeypox virus has been found in semen up to eight weeks after infection. The virus might be transmitted to others by infected semen, so condom usage is recommended for that period of time after infection.

Men having multiple sexual contacts with other men should get vaccinated. The vaccination process includes an initial vaccination followed by an additional vaccination one month later. We are now vaccinating using an intradermal method. This approach uses a smaller amount of vaccine without reducing efficacy. This gives us the opportunity to vaccinate more people with the limited supply of vaccine we currently have. As the supply of vaccine increases the populations of who should be vaccinated will be expanded. If you have had Monkeypox, you have natural immunity, and should not be vaccinated. Eventually, with vaccinations, we will be able to control Monkeypox.The vaccine has been proven to be effective.

Since 1980 Dr. Paul Benson’s Be Well Medical Center has been an inclusive medical center celebrating diversity. Do you have a health related question for Dr. Paul Benson and Dr. Mark Bornstein? Submit your questions to [email protected]. This article is a sponsored editorial produced in collaboration with Be Well Medical Center. Between The Lines’s journalism is made possible with the support and partnership of advertisers like Be Well. Learn more about Be Well here.


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